As part of a series about Americans' response to the H1N1 flu outbreak, the Harvard Opinion Research Program at the Harvard School of Public Health is releasing a national poll that focuses on Americans' views and concerns about the potential for a more severe outbreak of Influenza A (H1N1) in the fall or winter. The polling was done June 22-28, 2009.

Likelihood of Serious Outbreak

Approximately six in ten Americans (59%) believe it is very or somewhat likely that there will be widespread cases of Influenza A (H1N1) with people getting very sick this coming fall or winter. Parents are more likely than people without children to believe this will occur, with roughly two thirds of parents (65%) saying it is very or somewhat likely compared to 56% of people without children.

"These results suggest Americans are likely to support public health officials in prioritizing preparations for the possibility of a serious H1N1 outbreak in the fall or winter," said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Public Concern About Risk of Getting Ill Personally

Despite a majority believing that a serious outbreak is likely, more than half of Americans (61%) are not concerned about their personal risk-that is, that they or their family members will get sick from influenza A (H1N1) in the next year. This level is unchanged since the previous poll conducted May 5-6, 2009. The current survey further suggests that the World Health Organization (WHO)'s decision to raise the worldwide pandemic alert level to Phase 6 did not dramatically impact Americans' level of concern about their personal risk. Only 22% of Americans knew that the WHO had raised the level, and only 8% of Americans said it made them more concerned that they or their family would get Influenza A (H1N1) in the next 12 months.

Problems for Parents

One approach that has been used in the recent outbreak as a means to slow the spread of Influenza A (H1N1) is the closing of schools. In this survey, substantial numbers of parents who have children in school or daycare report that two-week closings in the fall would present serious financial problems for them. About half (51%) of these parents report that if schools/daycares closed for two weeks, they or someone else in their household would likely have to miss work in order to care for the children. Forty-three percent of these parents report that they or someone in their household would likely lose pay or income and have money problems; 26% of these parents report that they or someone in their household would likely lose their job or business as a result of having to stay home in order to care for the children.

The situation is likely to be worse for minority parents. More African American and Hispanic parents of children in school/daycare indicate that they are likely to lose pay or income and have money problems (56% and 64% respectively), as compared to whites (34%). And, more African American and Hispanic parents of children in school/daycare report that they or someone in their household would likely lose their job or business (40% and 49% respectively), as compared to whites (14%).

Problems Overall

If the outbreak in the fall or winter is serious and leads to large-scale workforce absenteeism, the survey suggests the possibility of substantial difficulties for many people and the economy as a whole. If people had to stay home for 7-10 days because they were sick or because they had to care for a family member who was sick, 44% indicate that they would be likely to lose pay or income and have money problems, and 25% reported that they would be likely to lose their job or business.

"The findings highlight the important role that employers would play during a future outbreak. Flexibility in their employee policies may help minimize some of the problems identified in this survey," said Blendon.

Recent Experience with H1N1

At the time of this survey, 27% of Americans reported that there had been cases of influenza A (H1N1) among people in their community, and 18% reported that schools in their community had closed due to influenza A (H1N1). Since the beginning of the outbreak, roughly two-thirds of people report that they or someone in their household has washed their hands or used sanitizer more frequently (62%).

"Handwashing was a major focus of public health education during the recent outbreak. The results of this survey show that these efforts helped people protect themselves," said Blendon.

This is the third in a series of polls about Americans' response to the H1N1 flu outbreak.

The first survey was released May 1, 2009.

The second survey was released May 8, 2009.

Methodology

This is the 31st in a series of studies on the public and biological security by the Harvard Opinion Research Program (HORP) at Harvard School of Public Health. The study was designed and analyzed by researchers at the Harvard School of Public Health (HSPH). The project director is Robert J. Blendon of the Harvard School of Public Health. The research team also includes Gillian K. SteelFisher, John M. Benson, and Kathleen J. Weldon of the Harvard School of Public Health, and Melissa J. Herrmann of SSRS/ICR. Fieldwork was conducted via telephone (including both landline and cell phone) for HORP by SSRS/ICR of Media (PA) June 22-28, 2009.

The survey was conducted with a representative national sample of 1,823 adults age 18 and over, including oversamples of parents, non-Hispanic African Americans and Hispanics, and specifically parents who are non-Hispanic African Americans and Hispanics. Altogether 315 non-Hispanic African Americans and 260 Hispanics were interviewed. The number of parents in total is 744, which includes 115 non-Hispanic African American parents and 131 Hispanic parents. In the overall results, these groups were weighted to their actual proportion of the total adult population.

The margin of error for the total sample is plus or minus 2.8 percentage points. Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, education, region, and number of adults in the household. Other techniques, including random-digit dialing, replicate subsamples, and systematic respondent selection within households, are used to ensure that the sample is representative.